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Abutment selection in fixed partial denture - A review

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 Review Article

Abutment selection in fixed partial denture - A review

M. H.Rathna Subhashini, G. Abirami, Ashish R. Jain

ABSTRACT

Fixed partial denture (FPD) replacements for teeth have taken a variety of designs throughout the years. Many principles
involved in the preparation and construction of fixed prostheses are still dominating, although more compatible and resilient
materials have been introduced in recent years. FPD transmits forces through the abutment to the periodontium. Failures
are due to poor engineering, use of improper material, inadequate tooth preparation and faulty fabrications. Therefore, it
is important to select abutment in FPD. The clinicians must recognize the forces developed by the oral mechanism and the
resistance of the tooth and its supporting structures to them. This article will review the conditions and requisites for the
selection of abutment for FPDs for the long-term success of fixed dental prosthesis.

KEY WORDS: Abutment, Crown root ratio, Fixed prosthesis, Occlusal anatomy, Surface area

INTRODUCTION is significant to determine the absolute need to fill a

Replacement of missing teeth represents the largest
category among patients in clinics who are looking
for better esthetic and/or functional teeth.[1] The fixed
partial denture (FPD) is one of the most commonly
preferred definitive treatment options for a single
missing tooth. For many years, FPDs were considered
to be the best treatment choice for replacing a single
missing tooth. Fixed prosthodontics’ treatment can
range from the restoration of a single tooth to the
rehabilitation.[2] Single teeth can be restored to full
function, and improvement in cosmetic effect can be
achieved. Missing teeth can be replaced with prostheses
that will improve patient comfort and masticatory
efficiency, maintain the health and integrity of the
dental arches. Every restoration must not be able to
withstand the occlusal forces to which it is subjected.
This is to particular significance when designing and
fabricating a FPD since the forces that would normally
be absorbed by missing tooth are transmitted through
the pontic, connectors, and retainers.[2,3] Abutment
teeth are called on to withstand the forces normally
directed to the missing plane teeth, in addition to those
usually applied to the abutments. The replacement of
the missing teeth in the posterior region is equally
important as in the anterior segment of the mouth. It
space and to perform a cost–benefit analysis for any
designed restoration -  not only in commercial terms
but also in biological value to tooth structure and
the surrounding tissues.[4,5] The maximum number
of posterior teeth that allows replacing with a FPD
is usually two. In rare circumstances, three can be
replaced, but that should be attempted only under
ideal conditions.[6] As abutment selection places an
important role in the success of fixed prosthesis, this
review invigilates the evaluation of factors influencing
abutment selection for FPD.
FACTORS AFFECTING
ABUTMENT SELECTION
Diagnostic Cast
Accurate diagnostic casts must be correctly oriented to
the transverse hinge axis and the plane of occlusion on
an articulator to permit eccentric movements similar
to those that take place in the mouth. Rotated and
malposed teeth can be easily observed. The form and
contour of prospective abutment teeth and the gingival
tissues can be visualized as well as the alignment and
contacts of opposing teeth.[7,8] This procedure provides
a simple evaluation of the occlusal relationships of the
dental arches and the abutment teeth [Figure 1].[8]

Access this article online Radiographic Evaluation

Website: jprsolutions.info ISSN: 0974-6943
The primary purpose of roentgenograms is to
disclose hidden areas and structures such as the root

Department of Prosthodontics, Saveetha Dental College and Hospital, Saveetha University, Chennai, Tamil Nadu, India

*Corresponding author: Dr.  Ashish R. Jain, Department of Prosthodontics, Saveetha Dental College and Hospital,
Saveetha University, Poonamalle High Road, Chennai – 600  077, Tamil Nadu, India. Phone: +91-9884233423.
E-mail: dr.ashishjain_r@yahoo.com

Received on: 17-12-2017; Revised on: 25-01-2018; Accepted on: 14-03-2018

Drug Invention Today | Vol 10 • Issue 1 • 2018 111

 M. H. Rathna Subhashini, et al.
morphology, pulp outline, the periodontal ligament
space, the alveolar bone, infrabony defects, residual
roots, impacted or supernumerary teeth, and the extent
of present or past caries. Peripheral and bitewing films
are most important in the selection of abutment teeth
[Figure 2].[9] It also helps in assessment of crown root
ratio, pulpal status, and periapical status.[9-11]
Crown Root Ratio
This ratio is the measure of the length of tooth,
occlusal to the crest of alveolar bone compared with
the length of tooth embedded into the bone. As the
level of alveolar bone moves apically, the lever arm
of that position out of the bone increases and the
chances of harmful lateral force increases [Figure 3].
A  prosthodontic textbook considers a (CRR) Crown
Root Ratio for an FPD abutment of 1:2 to be ideal,
but in practice, this is rarely observed.[4] An optimum
crown root ratio for an abutment is 2:3. The ratio of
1:1 is the minimum ratio acceptable for abutment
under normal circumstances. The CRR definition has
several inherent shortcomings. The ratio is based on
linear measurements only; however, when evaluating
abutment teeth, the clinician should assess the status
of the alveolar bone height and the total supported root
surface of the abutment tooth.[7] Dykema, suggested
a ratio of 1:1.5 as an acceptable and desirable CRR
for abutments, although the authors state that the less
favorable proportion may be acceptable when the
periodontium is in healthy condition, and the occlusion
is controlled.[5,7] The longer the edentulous span and
the greater the torques on the abutment teeth, the more
favorable the crown-to-root ratio must be. The use of
multiple abutments can sometimes compensate for
poor crown-to-root ratios or for a long span.[7,12]
Periodontal Surface Area
Introduced by Ante (1926) and later by Johnston
et al. (1971). The combined pericemental area of the
abutment teeth should be equal to or greater to the
pericemental area than the teeth to be replaced (Ante’s
Law).[13,14] In the case, where the periodontal surface area
is inadequate, the multiple teeth abutment is indicated
depending on other biomechanical factors.[13] The total
mesiodistal width of the cusps of abutments should
equal or exceed the width of the cusps of points. This
relationship assures that the occlusal load transmitted
to the abutment teeth will not be more than twice the
amount normally supported by these teeth individually
[Figure 4]. Larger teeth have greater surface area and
are better able to bear added stresses. The areas of
various teeth are reported by Marcum.[13-16]
Buccolingual Dimensions of Tooth
The occlusal surface of the pontics should harmonize
with the buccolingual dimension of the natural
unmutilated teeth, and recreate the normal buccal
112
and lingual form to the height of contour [Figur 5].
Reducing the width of the pontics does not materially
reduces the force transmitted to the abutments, but
merely places heavier per unit stress on the restoration
and produces conditions in the pontic.[6,9,10]
Arch Form
Parfitt (1960) have shown that the faciolingual
movement ranges between 56  µm and 108 µm, and
intrusion of 28 µm. Teeth in different segments of the
arch move in different directions. Due to the curvature
of the arch, the faciolingual movement of an anterior
tooth occurs at a considerable angle to the faciolingual
movement of the molar.[3] Restorations involving
anterior teeth are shaped in the form of any arc.
When forces are applied to the pontics, a rotational
effect occurs on the abutments, and a vertical force
is exerted on the terminal ends of the fixed partial
denture.[7] The lever arm is determined by drawing a
perpendicular line from the fulcrum line to the point
on the pontics farthest from this line [Figure 6]. The
fulcrum is a line joining the abutments adjacent to
the edentulous space at the proximo-occlusal angles
of the preparation. The greatest leverage occurs when
the four maxillary incisors are replaced in a narrow
tapered arch. The presence of a single incisor will
considerably shorten the lever arm. A long lever arm
can be equalized by using additional abutments. The
first premolars sometimes are used as secondary
abutments for a maxillary four pontic canine to the
canine fixed partial denture.[12,13,17] Due to the tensile
forces that will be applied to the premolar retainers,
they must have excellent retention.
Occlusal Anatomy
Occlusal anatomy has an indirect influence on loads
transmitted. The ridges and grooves increase the
sharpness and shearing action of teeth and reduce
friction between the opposing surfaces by keeping the
contact area to the minimum. This permits the most
efficient mastication and reduces the load transmitted.
Stallard points out that worn down teeth need more
muscular power and longer and more masticatory
strokes to chew food enough.[18,19] Much of this force
is directed at right angles to the long axis of the teeth.
Properly articulated ridge bearing cusps will cut the
food rapidly, with fewer strokes, with much less
muscular effort, and will direct most of the closure
forces perpendicularly in line with the long axis of the
teeth [Figure 7].
Root Configuration
This is an important assessment of abutment’ suitability
from periodontal standpoint. The tooth with conical
roots can be used for a short span if all other factors are
optimal [Figure 8]. Tooth with longer root is stronger
abutments than short roots. Labiolingually conical
Drug Invention Today | Vol 10 • Issue 1 • 2018
 M. H. Rathna Subhashini, et al.

Figure 1: Diagnostic cast b c

Figure 4: (a-c) Periodontal surface area

Figure 2: Radiographic evaluation

Figure 5: Abutment tooth width

a b

c
Figure 3: (a) Ratio- 3:1 (not accepted), (b) ratio- 1:1 (least
accepted), (c) ratio- 2:3 (ideal)

Figure 6: Arch form

roots are stable than circular roots. Apical divergence
should be greater than apical convergence.[9] Multi-
rooted posterior teeth which are widely separated are uniformly distributed by the presence of additional
more preferable than conical or fused root.[7,20,21] abutments.[17-19,21]

Crown Form Crown Length

Additional forces may result from good morphology Pontics with increased occlusogingival height
of the adjacent teeth or pontics. The forces can be require additional abutment. Abutment teeth with

Drug Invention Today | Vol 10 • Issue 1 • 2018 113

 M. H. Rathna Subhashini, et al.

<4 mm crown can be supported by splinting multiple

abutments.[15-17,21]

Axial Alignment
The axial alignment is the long axis of the abutment
teeth to each other. A  tilt up to 25° for full veneer
preparation and 15° for resin-bonded bridges.

Alveolar Ridge Form

Ideally, the ridge should be flat and wide. Excessive
resorption can lead to low and thin ridges, along with
high pontics and increased torsional forces.

Span Length Figure 7: Occlusal anatomy

Bending or deflection varies directly with the cube
of the length and inversely with the cube of the
occlusogingival thickness of the pontic. Long-span
prosthesis provides greater flexion.

Esthetics
Full coverage crown provides better esthetics and
retention. Anterior abutments with long connectors
also provide good esthetics.
a b
Pulpal Health
Vital teeth are often preferable due to better
proprioception. Inadequate pulpal heath can lead to poor
prognosis. Necessary treatment may be required before
restoration such as prophylactic root canal therapy.

Psychology c d

Mentally compromised patients may require multiple
splintered abutments. Splinted abutments help to
distribute parafunctional forces.
Phonetics
Abutment should not be bulky as it may affect the
patient’s phonetics.
Prognosis
A prosthesis should last for at least 60% of the time in
the span of 20 years.
Mutilation
Sufficient abutment height of at least 4 mm should be
present. Core build up with composite resins can be
done for tooth <4 mm occluso-gingivally.
Mobility
Teeth with Grade  1 mobility can be splinted with
additional abutments while teeth with Grade 2 mobility
are contraindicated. Strong periodontal support can
provide better support and stability.
CONCLUSION
Competent treatment depends on the careful
examination of all available information, a definitive
Figure 8: (a) Long root, (b) curved root, (c) straight root
(d) conical root
diagnosis, and a realistic treatment plan that offers a
favorable prognosis. A  comprehensive, sequential
approach to treatment planning is essential. Planning
for fixed prosthesis should not be independent of
other disciplines of dentistry. When planning and
treating fixed prosthesis cases, it is important that all
the applicable parameters are taken into account. As
a suggested clinical guideline for the evaluation of
abutment teeth, the clinician should use the CRR, total
alveolar bone support, root configuration, opposing
occlusion, presence of a parafunctional habit, pulpal
condition, presence of endodontic treatment, and the
remaining tooth structure. Thus, this review provides
an overview of the factors influencing abutment
selection to facilitate long-term success of fixed dental
prosthesis.
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Source of support: Nil; Conflict of interest: None Declared
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